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State governments looking to save a little money should not
reduce funding for circumcisions, according to researchers at
Johns Hopkins University. Currently, 18 states do not provide
Medicaid funding for infant circumcision, and San Francisco has
attempted to ban the procedure.

In an editorial to appear Wednesday (Oct. 5) in the Journal of
the American Medical Association (JAMA), Hopkins doctors Ronald
Gray and Aaron Tobian said the increasing efforts to defund or
outright ban infant male circumcision are unfounded, harmful and
"ethically questionable."

Decreasing funding for Medicaid, the researchers said, would hurt
the most vulnerable: certain minority groups and the poor who
rely on Medicaid and who suffer from higher STD rates compared
with the general population. In Washington, D.C., 7.1 percent of
African-American males are HIV-positive, and heterosexual sex is
the most common mode of transmission among them, Tobian said.
"Male circumcision decreases dramatically when not covered by
insurance," Tobian added.

"If a vaccine was available that reduced HIV risk by 60 percent,
genital herpes risk by 30 percent and HR-HPV [cervical cancer
virus] risk by 35 percent, the medical community would rally
behind the immunization, and it would be promoted as a
game-changing public health intervention," Tobian told
LiveScience.

Instead, in 2011, Colorado and South Carolina, joined 16 other
states in denying Medicaid coverage of circumcision. In July, the
San Francisco initiative to ban male circumcision was removed
from the city's November ballot because of a legal technicality.
Just this weekend, Calif. Gov. Jerry Brown signed into law a bill
that prevents local governments from banning male circumcision in
the state.

Many who oppose the practice of infant male circumcision say that
it violates the child's rights to decide for himself or that
it reduces sensitivity during sex. But Tobian said that
parents make health decisions for children all the time. Waiting
until the child turns 18 places him at risk for STDs.

"Based on the medical evidence, banning infant male circumcision
would deprive parents of the right to act on behalf of their
children's health," the researchers wrote in the editorial.

As for sex, studies conducted in the last five years in Africa,
Europe and North America of men circumcised as adults have
revealed either no difference in sensitivity or an increase in
sexual pleasure for both men and their partners.

Some compare
infant male circumcision with female genital mutilation,
which entails partial or total removal of the external female
genitalia or injury to the genital organs for nonmedical reasons.
Most health authorities dismiss the comparison, however, on
grounds that male circumcision has no lasting negative impact,
barring a rare neonatal infection, and is not performed as a
means of subjugation.

Nevertheless, worldwide, infant male circumcision is rare, with
the United States being the last bastion of the practice for
non-religious reasons. Over 60 percent of newborns were
circumcised in 2000, according to the Centers for Disease Control
and Prevention (CDC), although current rates might have dropped
to about 56 percent, according to the federal Agency for
Healthcare Research and Quality.

Rates recently have plummeted in Canada and Australia, where
infant circumcision is now rare. And aside from the Muslims and
Jews who perform circumcisions as part of a religious tradition,
the procedure has become nearly non-existent since the 1960s in
all of Latin America, Europe and Asia; and Sweden and Finland
restrict most circumcisions.

Tobian and Gray could not offer an explanation for the global
trend nor speculate in its impact on public health, other than to
say that parents should have the right to choose whether their
child should be circumcised.